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目的:介绍标准型人工全关节置换术应用于颞下颌关节重建的方法,初步评价其疗效及应用价值。方法:6例(10侧)颞下颌关节病患者,年龄49～66岁,平均59岁。3例(5侧)有既往颞下颌关节手术治疗史,3例(5侧)为内紊乱伴骨关节炎。术前均有明显开口受限及关节区疼痛,开口度1.0～2.9cm,平均1.9cm。采用标准型人工关节置换术,术后定期观察开口度及关节疼痛等变化,结合影像学检查等评价治疗效果。结果:成功完成6例(10侧)人工关节置换术。术后随访7～49个月,平均17.5个月。植入关节未出现因感染、排异、松动或断裂等导致的失败。有既往手术的病例中,1例(2侧)发生假体内侧异位成骨,1例(2侧)耳颞区疼痛无法缓解,其余4例(6侧)开口受限及关节区疼痛均有较明显改善。影像学检查均未见假体松动等异常情况。结论:标准型人工全关节置换术对缓解关节疼痛有明显效果,可有效改善开口度及提高咀嚼能力,但对咀嚼肌疼痛的缓解效果不理想。
Objective: To introduce the method of standard artificial total joint replacement in the reconstruction of temporomandibular joint and to evaluate its curative effect and application value. Methods: Six cases (10 sides) of temporomandibular joint disease patients, aged 49 to 66 years, mean 59 years. Three patients (5 sides) had previous surgical treatment of temporomandibular joint, and 3 patients (5 sides) had internal disorder with osteoarthritis. Before surgery, there are obvious openings and joint pain were limited, the opening 1.0 ~ 2.9cm, an average of 1.9cm. Standard artificial joint replacement surgery, regular observation of open degree and joint pain and other changes, combined with imaging studies to evaluate the treatment effect. Results: Six cases (10 sides) of artificial joint replacement were successfully completed. The patients were followed up for 7 to 49 months with an average of 17.5 months. Implantation joints did not appear due to infection, rejection, loosening or rupture caused by failure. One case (2 sides) had ectopic osteogenesis in one case (2 sides), one case (2 sides) failed to relieve pain in the ear-temporal area, and the other 4 cases (6 sides) had limited opening and joint pain There is a clear improvement. Imaging examination showed no abnormalities such as loose prosthesis. CONCLUSION: Standard artificial total joint replacement has obvious effect on alleviating joint pain, which can effectively improve the opening degree and improve the masticatory ability, but its effect on masticatory muscle pain is not satisfactory.